TREATMENT OF CUSHINGS-DISEASE BY O,P'DDD - SURVEY OF 62 CASES

In a study of nonsurgical therapy of Cushing's disease, 62 patients received O,p′-dichlorodiphenyldichloroethane (O,p′DDD), 16 of whom also received cobalt irradiation of the pituitary. After an initial treatment period averaging eight months, a remission of the disease was obtained in 38 of the 46 patients given O,p′DDD alone and in all patients who received drug combined with radiation. Although 60 per cent of these patients subsequently relapsed, additional courses of drug or radiation therapy were usually effective, and 63 per cent of the entire group of patients have so far been kept under control without adrenalectomy. (Forty patients have been followed for at least two years after the initial course of treatment.) O,p′DDD produced little gastrointestinal discomfort; an increased serum cholesterol was the main side effect. This drug allows long-term medical management of Cushing's disease in most cases. Whether the combination of O,p′DDD with pituitary radiation is the best therapy has not been established. (N Engl J Med 300:459–464, 1979) CUSHING'S disease is the result of excessive pituitary ACTH secretion, leading to bilateral adrenal hyperplasia and excessive cortisol secretion. No treatment of this disease has been fully satisfactory, since bilateral total adrenalectomy can result in death1 or Nelson's syndrome,2 and requires substitutive hormonal therapy. Pituitary surgical procedures are usually limited to cases with enlarged sella turcica, though pituitary adenoma seems to be more frequent than previous observers believed.3,4 Pituitary irradiation by cobalt, which appears to be safe and efficient in children,5 often does not provide a stable remission in adults.6 Proton-beam irradiation is more efficient, but more dangerous.7 Medical therapy. © 1979, Massachusetts Medical Society. All rights reserved.